Assuntos
Melanoma/diagnóstico , Pescoço/patologia , Nevo Sebáceo de Jadassohn/diagnóstico , Verrugas/patologia , Adulto , Biópsia , Dermoscopia/métodos , Erros de Diagnóstico , Humanos , Ceratose/patologia , Melanócitos/patologia , Melanoma/patologia , Nevo Sebáceo de Jadassohn/patologia , Papiloma/patologia , Transtornos da Pigmentação/patologia , Neoplasias Cutâneas/patologia , Pigmentação da PeleRESUMO
Functional - or somatoform - symptoms are those that arise with no proven organic pathology. Also known as 'medically unexplained' symptoms, they can present in any medical speciality, including dermatology. Mucocutaneous pain syndromes and functional pruritus are two examples of functional disorders encountered by dermatologists. Patients presenting with somatoform symptoms have paradoxically complex and often subjectively severe symptomatology, yet minimal abnormalities on clinical examination or investigation. Such disparity can be frustrating and distressing for patients and clinicians alike, and there are many pitfalls regarding overinvestigation and misleading communication. However, with an honest and open approach - sometimes requiring collaboration with psychological services - management of functional symptoms can be effective, and patients can be successfully rehabilitated.
Assuntos
Dor Crônica , Doença Ambiental/psicologia , Transtornos Somatoformes , Anafilaxia , Dor Crônica/etiologia , Dor Crônica/psicologia , Humanos , Prurido/diagnósticoRESUMO
Functional disorders within dermatology present as various constellations of skin symptoms, but without evidence of organic pathology. Examples can include mucocutaneous pain syndromes, functional pruritus, somatoform pain disorder and rarer entities, such as undifferentiated somatoform idiopathic anaphylaxis and multiple chemical sensitivity syndrome. These conditions can have a significant impact on a patient's quality of life, and can present challenges in communication, investigation and management. The aetiology of functional disorders is not fully understood, but with an effective collaborative approach, a psychological explanation for these symptoms is often found. A structured approach to assessment can lead to a confident diagnosis, and understanding a patient's belief system and the impact of symptoms on their functioning can give better grounding for successful management. Treatment is dependent on the level of the patient's engagement with healthcare professionals, and often takes a measured and rehabilitative approach. Psychological therapies have been shown to be effective, often alongside both psychopharmacological and topical medications.
Assuntos
Anafilaxia , Dor Crônica , Doença Ambiental , Prurido , Transtornos Somatoformes , Anafilaxia/diagnóstico , Anafilaxia/terapia , Dor Crônica/diagnóstico , Dor Crônica/terapia , Doença Ambiental/diagnóstico , Doença Ambiental/terapia , Humanos , Prurido/diagnóstico , Prurido/terapia , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/terapiaAssuntos
Fármacos Dermatológicos/efeitos adversos , Isotretinoína/efeitos adversos , Saúde Mental/estatística & dados numéricos , Transtornos do Humor/induzido quimicamente , Acne Vulgar/tratamento farmacológico , Acne Vulgar/psicologia , Depressão/induzido quimicamente , Depressão/epidemiologia , Depressão/psicologia , Dermatologistas/estatística & dados numéricos , Dermatologia/organização & administração , Humanos , Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Prevalência , Fatores de Risco , Escócia/epidemiologia , Suicídio Consumado/estatística & dados numéricos , Inquéritos e QuestionáriosAssuntos
Fármacos Dermatológicos/efeitos adversos , Fibrose Pulmonar Idiopática/induzido quimicamente , Metotrexato/efeitos adversos , Psoríase/tratamento farmacológico , Idoso de 80 Anos ou mais , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/uso terapêutico , Evolução Fatal , Humanos , Metotrexato/administração & dosagem , Metotrexato/uso terapêuticoAssuntos
Antipruriginosos/administração & dosagem , Prurido/terapia , Administração Cutânea , Adulto , Idoso , Terapias Complementares , Toxidermias/complicações , Ectoparasitoses/complicações , Emoções , Doenças do Sistema Endócrino/complicações , Previsões , Doenças Hematológicas/complicações , Humanos , Infecções/complicações , Deficiências de Ferro , Sobrecarga de Ferro/complicações , Hepatopatias/complicações , Transtornos Mentais/complicações , Neoplasias/complicações , Doenças do Sistema Nervoso/complicações , Fototerapia/métodos , Atenção Primária à Saúde , Prurido/diagnóstico , Prurido/etiologia , Uremia/complicaçõesAssuntos
Eritromelalgia/etiologia , Dermatoses Faciais/etiologia , Síndrome da Taquicardia Postural Ortostática/complicações , Adulto , Eritema/etiologia , Eritromelalgia/diagnóstico , Dermatoses Faciais/diagnóstico , Feminino , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/etiologia , Humanos , RecidivaAssuntos
Carcinoma de Células Escamosas/etiologia , Pavilhão Auricular/patologia , Neoplasias da Orelha/etiologia , Cisto Epidérmico/complicações , Infecções por Papillomavirus/complicações , Neoplasias Cutâneas/etiologia , Idoso , Biópsia , Transformação Celular Neoplásica , Cisto Epidérmico/patologia , Cisto Epidérmico/virologia , Humanos , Masculino , PapillomaviridaeRESUMO
The incidence, clinical characteristics and management of lentigo maligna (LM) were assessed in a university hospital setting in 2005 and 2014. Multiple clinical variables were compared, and 28 and 43 cases, respectively were identified during the two time periods. The most common site of presentation was the cheek (50% vs. 44%), and an accurate clinical diagnosis of LM was made in 60% vs. 72%) of cases. Most of the patients received surgical treatment (75% in 2005 vs. 97% in 2014), with 47% and 33% of excisions, respectively, remaining involved at the peripheral surgical margin. During the 10-year follow-up for the 2005 cohort, 7 of the 28 patients had recurrence (3 of whom already had previously involved margins following surgery). This study shows that making an accurate clinical diagnosis of LM remains a significant challenge. Although surgery has become the preferred management option, achieving clear excision remains difficult, with involved margins increasing the risk of local recurrence and need for further intervention.
Assuntos
Sarda Melanótica de Hutchinson , Neoplasias Cutâneas , Adulto , Aminoquinolinas/uso terapêutico , Antineoplásicos/uso terapêutico , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Sarda Melanótica de Hutchinson/diagnóstico , Sarda Melanótica de Hutchinson/epidemiologia , Sarda Melanótica de Hutchinson/terapia , Imiquimode , Incidência , Masculino , Pessoa de Meia-Idade , Radioterapia/métodos , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/terapia , Procedimentos Cirúrgicos Operatórios , Conduta ExpectanteAssuntos
Anestesia Local/efeitos adversos , Cirurgia de Mohs/efeitos adversos , Satisfação do Paciente , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Local/psicologia , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs/psicologia , Segurança do Paciente , Neoplasias Cutâneas/psicologiaRESUMO
BACKGROUND: Little is known about U.K. dermatologists' treatment approaches towards adult patients with recalcitrant moderate-to-severe atopic eczema. OBJECTIVES: We wanted to learn about (i) treatment approaches used for this disease in the U.K.; (ii) factors that influence treatment decisions and (iii) perceived gaps in evidence on treatment safety and efficacy, and priorities for future trials. METHODS: We conducted an online survey of consultant-level dermatologists in the U.K. RESULTS: Sixty-one respondents from over 30 centres reported on management of moderate-to-severe atopic eczema in adults, outwith the context of an acute flare. Phototherapy or psoralen-ultraviolet A was the most common therapeutic modality chosen first line (46%), and this was usually narrowband ultraviolet B. Systemic therapy was chosen as a first-line approach by 36% of dermatologists. Azathioprine was the commonest drug reported being used as first line followed by oral corticosteroids, ciclosporin and methotrexate. Methotrexate was the most common second-line treatment of respondents. The key factors that influenced decision making on the use of phototherapy and systemic agents were the respondent's clinical experience, results of baseline tests (systemic agents) and knowledge of both efficacy and acute and chronic side-effect profiles. The most important evidence gaps identified were the relative effectiveness of treatments, the alternatives to current approaches and the safety of long-term maintenance treatment. With regard to future trials, respondents suggested that priority should be given to studies involving methotrexate. CONCLUSIONS: While survey study designs have limitations, we found that phototherapy, in particular narrowband ultraviolet B, was respondents' preferred first-line treatment for adults with recalcitrant moderate-to-severe atopic eczema, perhaps reflecting access to, and clinical experience of, this approach. Azathioprine is widely used as a longer-term maintenance treatment.